Uploaded August 2026 | Updated September 2026, 2 weeks ago
An 82-year-old man presented after being “found down.” One week earlier, he had returned from a 1-month visit to Chad, his country of birth, and had started having weakness. His body temperature was 37.4°C, and his blood pressure was 88/47 mm Hg. The physical examination was notable for confusion. Laboratory studies showed a hemoglobin level of 12 g per deciliter (reference range, 13.5 to 17), an elevated lactate dehydrogenase level, thrombocytopenia, metabolic acidosis, and acute kidney injury. A peripheral-blood smear is shown. Which of the following is the most appropriate next step in management? Submit your answer at NEJM.org.
#nejm
An 82-year-old man presented after being “found down.” One week earlier, he had returned from a 1-month visit to Chad, his country of birth, and had started having weakness. His body temperature was 37.4°C, and his blood pressure was 88/47 mm Hg. The physical examination was notable for confusion. Laboratory studies showed a hemoglobin level of 12 g per deciliter (reference range, 13.5 to 17), an elevated lactate dehydrogenase level, thrombocytopenia, metabolic acidosis, and acute kidney injury. A peripheral-blood smear is shown. Which of the following is the most appropriate next step in management? Submit your answer at NEJM.org.
#nejm
